Labor Characteristics And Intrapartum Interventions In Women With Vaginal Birth After Cesarean Section

Abstract

Background: Cesarean delivery is the most frequently performed surgical procedure worldwide. With the development of China’s Two-child-policy, vaginal birth after cesarean section (VBAC) has aroused a great public concern due to the fear of perinatal complications and uterine rupture. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. In this study, we aimed to provide clinical evidence of standardized intrapartum management in women with a trial of labour after cesarean section (TOLAC).Material and methods: This observational retrospective study enrolled all VBAC women who delivered vaginally with spontaneous labor at the Second Affiliated Hospital of Wenzhou Medical University from 2016 and 2019. They were allocated into observation A group (the previous cesarean section was performed before dilation of cervix) and observation B group (the previous cesarean section was performed after dilation of cervix). 149 primiparae constituted primipara control group and 155 multiparae with second vaginal birth constituted multipara control group. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.Results: The durations of labor, intrapartum interventions and maternal and neonatal outcomes in observation A group resembled to observation B group. However, compared with primiparae, women in observation group and observation A group had shorter first, second and the total stages of labor. Compared with multiparae, Women in observation group and observation B group had longer second stage of labor, but shorter third stage of labor. VBAC women were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.Conclusions: Labour characteristics in VBAC women with or without cervix dilation showed no significant difference, but differed significantly from those of multiparae and primiparae. Artificial rupture of membrane, oxytocin, phloroglucinol and epidural analgesia is regularly used for VBAC women. Episiotomy is encouraged to shorten the second stage of labor, while forceps delivery should be minimized whenever possible. We should be alert to the occurrence of postpartum hemorrhage in VBAC women.